Intramucosal Alpha-Fetoprotein-producing Early Gastric Cancer Without Vascular Invasion or Metastasis Diagnosed After Endoscopic Submucosal Dissection: A Case Report and Literature Review.

Alpha-fetoprotein-producing gastric cancer (AFPGC) is a rare histological subtype of gastric cancer that is often diagnosed at an advanced stage. In the present case, an elevated lesion was detected in the gastric antrum during upper gastrointestinal endoscopy screening and diagnosed as early gastric cancer of cT1a. The patient underwent endoscopic submucosal dissection (ESD), and pathological examination showed positive staining for AFP, leading to a diagnosis of AFPGC confined to the intramucosa (pT1a). An additional laparoscopic distal gastrectomy with lymphadenectomy was performed, which revealed no residual tumor and no lymph node metastasis. The patient has remained recurrence-free for 4 years after the additional surgery. Intramucosal gastric cancer with AFP production is extremely rare, and limited data are available regarding the need for additional surgical resection after ESD. Notably, a previous case of metastatic recurrence in AFPGC of cT1a was reported. Therefore, treatment decisions should be made on the basis of a thorough discussion and the patient's full informed consent.